What causes anxiety problems? Experts think biology and environment play a role.

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Some people with generalized anxiety disorder worry constantly over making simple decisions, such as what to cook for a dinner party. Those with obsessive-compulsive disorder fear that the worst will happen — even that someone they love will die — if they don’t perform specific daily rituals. Others have phobias so intense, whether it’s a fear of heights, dogs, or something else, that just thinking about it makes their hearts pound and their palms sweat.

At the root of all these anxiety problems is the question of what causes the anxiety — what makes some people able to brush off the stress of public speaking, for example, while others become immobilized by fear?

The answer depends on whom you ask, says Simon A. Rego, PsyD, supervising psychologist at Montefiore Medical Center and assistant clinical professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, both in the Bronx, N.Y. Some experts say anxiety is a combination of genetics and environment, Rego says, while others say brain chemistry plays a role.

Anxiety Problems: The Role of Genetics and the Environment

We’re hard-wired to experience anxiety at some time in our life. The fight-or-flight response, which kicks in when we’re under stress, has been vital to human survival.

And we rely on stress on a regular basis. “You don’t want to be anxiety-free, or you wouldn’t get anything done,” Rego says. Stress and anxiety are what motivate people to show up to work on time and make deadlines.

But what makes some people more prone to anxiety than others? Most experts agree that anxiety happens due to a combination of biology and psychology, Rego says. Researchers believe that some people have a biological vulnerability, such as an overactive nervous system, that makes them more prone to anxiety. You can inherit this vulnerability the same way you inherit height and hair color, explains Rego.

In a recent study, researchers followed a group of people from birth to adulthood and found that babies who cried in new situations were 10 times more likely to have an anxiety disorder and be depressed as an adult. They also had a thicker prefrontal cortex and other anatomical differences in several areas of the brain involved in controlling emotional memories and the fear response. Calmer babies weren’t as likely to have depression or anxiety disorders or to have this type of structural difference in the brain.

Some people may have a psychological vulnerability to anxiety, in which they might have a more worrisome view of the world or they don’t tolerate some situations as well as others, Rego says. Each of us may have some type of vulnerability for anxiety, but it may take something in your environment to trigger it, kind of like a light switch that needs to be turned on, continues Rego. It could be something negative such as a job loss or terrorist attack, or it could be something positive but stressful, such as a wedding or the birth of a baby.

How biology and environment play out can be complicated. While experts have assumed in the past that trauma such as military combat was the sole cause of post-traumatic stress disorder (PTSD), not everyone who experiences trauma develops the disorder. Researchers now think that PTSD is due to an interplay between stress and genetic factors. A recent study involving 900 patients seeking medical care in Atlanta found that having a history of child abuse put them at significantly higher risk for PTSD, but having a variation in genes related to stress plus experiencing child abuse made them even more likely to develop this condition.

Older studies have found that a part of the brain called the hippocampus, which turns threatening events into memories, may be smaller in people who experienced child abuse or were in military combat. Experts think it could play a role in the memory problems that people with PTSD experience.

Anxiety Problems: The Role of Brain Chemistry

Another theory of anxiety involves brain chemistry. Psychologists have found that low levels of the neurotransmitter serotonin (a chemical released by nerve cells) are linked to anxiety problems and depression, Rego says. That has led to the class of prescription antidepressant drugs called selective serotonin reuptake inhibitors, or SSRIs, which has offered some people anxiety stress relief.

However, it’s hard to say that low levels of serotonin actually cause anxiety. Anxiety problems could be what lead to the low levels of serotonin. Also, while increasing serotonin can offer anxiety relief, so do non-drug treatments such as cognitive-behavioral therapy. People have shown higher levels of serotonin after those non-drug therapies. “The jury is still out as to which comes first,” Rego says.

Some anxiety is a natural response to stress. But knowing what lies behind the chronic anxiety that interferes with daily life can help doctors develop more effective treatment. With 40 million Americans having at least one form of anxiety, it’s an area well worth further study.

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